Signature Test page - Katherine West Health Board

Full name*

Position*

Company or organisation*

Do you need access to Communicare, our patient information recall system?*

Applicant’s Prescriber Number:

Registar Number:

Please upload your Membership or Registration from relevant body e.g. AHPRA

Max. file size: 50 MB.

Do you need Communicare training?*

Do you have a National Police Certificate?*

Please upload your National Police Certificate

Max. file size: 50 MB.

Do you have a Working with Children (Ochre) card?*

Please upload your Working with Children (Ochre) card

Max. file size: 50 MB.

Acknowledgement*

Signature*

By signing this form you acknowledge that you have read and understood the following documents: